超声引导腹横肌平面阻滞对小儿腹腔镜疝气术后应激及早期康复的影响

Effect of ultrasound-guided transversus abdominis plane block on stress and early recovery in children after laparoscopic hernia surgery

目的 观察超声引导腹横肌平面阻滞(TAPB)对小儿腹腔镜疝气术后应激及早期康复的影响。方法 择期行腹腔镜疝气修补手术,2~4岁的患儿共60例,随机均分为对照组(C组)和TAPB组(T组)各30例。C组给予喉罩插管全身麻醉,T组在喉罩全身麻醉后给予0.25%罗哌卡因每侧各0.5 mL/kg TAPB。对比两组不同时刻的MAP、HR、皮质醇(Cor)、血糖(Glu);记录患儿术后首次饮水及住院时间;记录术后FLACC疼痛评分、自主活动情况和并发症。结果 与C组相比,T组在T2时MAP和HR明显下降,在T1和T2时Cor和Glu明显降低(P <0.05)。T组术后首次饮水和住院时间均明显缩短(P <0.05)。T组术后2、4、8、12 h FLACC评分明显下降,布洛芬首次补救时间明显延迟,累计用量和使用次数明显减少(P <0.05)。T组术后4、8、12 h自主坐起、下地比例均高于C组,术后躁动的发生率明显降低(P <0.05)。结论 基于ERAS理念下超声引导TAPB在小儿腹腔镜疝气修补手术的应用是可行且有效的,可增强术后镇痛效果,降低全身应激反应,促进患儿术后早期自主活动和进食,加速术后康复。

Objective To observe the effect of ultrasound-guided transversus abdominis plane block on stress and early recovery in children after laparoscopic hernia surgery. Methods A total of 60 children aged 2 ~ 4 years who underwent elective laparoscopic hernia surgery were randomly divided into control group(group C,n = 30)and TAPB group(group T,n = 30). Group C was given general anesthesia with laryngeal mask intubation,and group T was given with 0.5 mL/kg of 0. 25% ropivacaine in transverse abdominis plane block on each side under the guidance of ultrasound after general anesthesia. MAP,HR,cortisol(Cor)and blood glucose(Glu)of the two groups were compared at different time points. The time of first postoperative drinking water and hospital stay were recorded. Postoperative FLACC pain score,autonomic activity and complications were compared. Results Compared with group C,MAP and HR of group T were significantly decreased at T2,while Cor and Glu were significantly decreased at T1 and T2(P < 0.05). The time of first postoperative drinking water and hospital stay in group T were significantly shorter(P < 0.05). The FLACC pain scores at 2,4,8 and 12 h were significantly decreased in T group. The first recovery time of ibuprofen was significantly delayed,and the accumulative dosage and frequency of ibuprofen were significantly decreased(P < 0.05). The proportion of independent sitting up and standing up in group T was higher than that in group C at 4,8 and 12 h after operation,while the incidence of agitation in group T was significantly reduced(P < 0.05). Conclusion The application of ultrasound-guided transversus abdominis plane block based on ERAS concept in laparoscopic hernia repair in children was feasible and effective,which could enhance postoperative analgesia effect,reduce stress response,promote early postoperative activity and eating,and accelerate postoperative recovery.